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Endo/Repro: Week 4 > Pearson: Contraception > Flashcards

Pearson: Contraception Flashcards

1
Q

What percent of contraception occur in women using contraception?

A

50-60%

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2
Q

What is method effectiveness?

A

THEORETICAL effectiveness if used PERFECTLY

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3
Q

What is user effectiveness?

A

ACTUAL effectiveness when studied in non-perfect world

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4
Q

What do natural methods require?

A
  • requires female w/ regular, predictable cycles

- both partners dedicated

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5
Q

When does ovulation usually occur?

A

Prior to 1st day of menses

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6
Q

When should you avoid intercourse w/ the calendar method?

A

5 days prior and 3 days after ovulation

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7
Q

How do you determine the fertile period?

A

Subtract 18 days from length of shortest cycle

Subtract 11 days from length of longest cycle

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8
Q

How can you use basal body temps as a natural method?

A

see rise in temp w/ progesterone

Should drop again if not pregnant, but will sustain if pregnant

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9
Q

What is cervical mucous during ovulation?

A

egg white consistency (most abundant, watery,)

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10
Q

What is the best STI protection?

A

Condoms

*more effective and commonly used than F common

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11
Q

When are condoms most effective?

A

If used w/ spermacide, dependent on user

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12
Q

What form of barrier method increases rate of UTI and must be inserted up to two hours before sex and left in for at least 6 hours after (but removed before 24)?

A

diaphragms

*must be re-fit if more than 10# wght change

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13
Q

What for of barrier method must be left in minimum of 6 hours after sex (max of 48 hrs total)?

A

Cervical caps

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14
Q

What form of barrier method can be hard to fit, can increase the risk of cervical dysplasia and toxic shock?

A

cervical cap

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15
Q

What form of barrier method increases rate of yeast infections, UTI and TSS if left in place for extended periods?

A

sponge

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16
Q

How do you use spermicide formulations?

A

Used before insertion of diaphragm or cervical cap
• Works by damaging cell membranes of sperm cells and bacteria
• Can cause topical irritation (urethritis in men)

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17
Q

What is the mechanism of combined estrogen/progesterone methods?

A

estrogen-progesterone induced inhibition of the midcycle surge of gonadotropin secretion (prevent LH/FSH) from surging

  • increases cervical mucous to prevent sperm penetration
  • makes endometrium less hospitable
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18
Q

What are contraindications for combined estrogen/progesterone methods (pill, ring, transdermal patch)?

A
  • Previous thromboembolic event or stroke
  • Hx of CAD
  • Hx of estrogen dependent tumor
  • Liver disease
  • Pregnancy
  • Undiagnosed abnormal uterine bleeding
  • Smoker over age 35
  • Migraine headaches w/ neurologic symptoms
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19
Q

What are relative contraindications for combined estrogen/progesterone?

A
  • Obesity
  • Inherited thrombophilias
  • Anticonvulsant therapy
  • Migraine headaches
  • Hypertension
  • Depression
  • Lactation
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20
Q

What are non contraceptive benefits of combined estrogen/progesterone?

A
  • Reduction in dysmenorrea
  • Reduction in menorrhagia
  • Reduction of ovarian, endometrial, and colorectal cancers
  • Improves acne
  • Improves benign breast disease
  • Improves osteopenia or osteoporosis
  • Decreases functional ovarian cysts
  • Decreases ectopic pregnancy rates
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21
Q

What medical concerns are associated w/ combined estrogen/progesterone?

A

• Increase in thromboembolic events (estrogenic component)
• Breast cancer risks – controversial and unproven
• Cervical cancer risks (more HPV than non sexually active women)
• Medication interactions
o Antimicrobials (Rifampin)
o Anticonvulsants
o Anti-HIV
o Herbal products (St. John’s Wort)

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22
Q

What are the components in “the pill”?

A

Estrogen (Ethinyl estradiol with doses from 10-50 mcg)

Progestin (varies)

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23
Q

What are Androgenic SE of “the pill”?

A

Earlier generations of the pill were more androgenic

  • Increased LDL and/or decreased HDL
  • Acne
  • Hirsutism
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24
Q

What are general SE from “the pill”?

A
  • Breast tenderness
  • Nausea
  • Headaches
  • Mood changes- anxiety, irritability, depression
  • Irregular bleeding/spotting
  • Weight changes/fluid retention
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25
Q

What is the least androgenic first generation?

A

o Norethindrone- LEAST androgenic 1st/2nd generation progestin. Slight improvement in lipid profile which is different from other 1st / 2nd gen. pills. More androgenic than newer progestins

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26
Q

What is a second generation progestin that is highly prescribed and in many formulations like Plan B and extended cycle pills?

A

Levonorgestel

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27
Q

What third generation progestins are a good choice for pts w/ dyslipidemia, acne, or other possible androgenic SE but have HIGHER thromboembolic potential?

A

Norgestimate and Desogestrel

2-3x higher thromboembolitic potential than 1st/2nd gen progestins

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28
Q

What is Yaz (drospirenone)?

A

Spironolactone analogue

anti-mineralcorticoid/lower androgenic effects

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29
Q

What are potential benefits and risk of Yaz?

A

Potential benefits
— Improves weight stability/water retention
— Improves other possible androgenic SEs

Potential risk: increased serum potassium and VTE risk** (renal disease/diuretic)

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30
Q

What is dienogest?

A

One of the latest!

for long difficult periods

4 phases
marketed for metromennorhagia

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31
Q

same fixed soe for 3 wks than placebo

A

monophasic

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32
Q

varying dose throughout first 3 wks than placebo wk

A

biphasic, triphasic

33
Q

84 days fixed dose hormones then placebo wk

A

Extended cycle (seasonale, lybrel)

  • Lybrel – fixed dose of estrogen/progestin 365 days/yr
  • Breakthrough bleeding more common but decreases over time
34
Q

How do you prescribe the “right” pill?

A
  1. Start with low to moderate dose estrogen with appropriate progestin considering co-morbid conditions
  2. Allow at least 2-3 cycles to assess
  3. Adjust based on SEs
  4. Follow-up based on SEs and co-morbid conditions
35
Q

How do you take the pills?

A
  1. First day of menses vs. Sunday start vs. quick start (to increase compliance)
  2. Take same time of day every day (if you want to switch the time wait until the next pill pack)
  3. Missed pills – take 2 the next day (if only missed 1) or may need to start over (if missed more than 1)
  4. Follow up: BP check, check for tolerance and SEs
36
Q

What are common SE of “the pill”?

A

Breakthrough bleeding
o In first 10 days → increase estrogen
o After 10 days → increase progestin

No withdrawal bleed
o Do pregnancy test
o Continue pills
o If pt wants menses to return, can increase estrogen

Typical “hormone related SEs”
o Adjust appropriate hormone component

37
Q

What hormones are in the NuvaRing?

A

15 mcg ethinyl estradiol and 120 mcg of etonogestrel daily

38
Q

How is the NuvaRing used?

A

left in for 3 weeks then left out for 1

39
Q

How does Nuva Ring compare to the Oral OCPs?

A
  • Comparable efficacy
  • Lower doses of hormones
  • Rapid return to ovulation
  • Ease and convenience
  • Similar SE’s, contraindications
  • Plastic NOT latex
40
Q

What hormone combination is in the ortho evra patch?

A

20 mcg of ethinyl estradiol and 150 mcg of norelgestromin daily

41
Q

How do you use the transdermal patch?

A
  • Change once a week for 3 weeks then 1 week patch free

* Apply to buttock, abdomen, upper arm, or torso (not breast)

42
Q

When should you use a back up method wtih the patch?

A

On for > 9 days, off for > 7 days

Falls off > 24 hrs

43
Q

How does the patch compare to OCPs?

A
  • Similar efficacy overall
  • Greater failure rate in women >90 kg.
  • Better compliance
  • More breakthrough bleeding, breast discomfort, dysmenorrhea, site reactions
  • FDA warning that women are exposed to more estrogen with patch than with most OCP’s- ?clinical implications long term
44
Q

What is the purpose of emergency contraception?

A

prevention of pregnancy within 72-120 hours of unprotected intercourse or failure of a contraceptive method

45
Q

What is the mechanism of emergency contraception?

A

depending on timing within menstrual cycle, can inhibit ovulation or prevent fertilization

46
Q

How does EC relate to post-fertilization effects? Will it abort an established pregnancy?

A
  • Greater possibility of a post-fertilization effect (if woman is later in her cycle) → endometrial changes inhospitable to a fertilized ovum
  • Will NOT abort an established pregnancy
47
Q

What is the mechanism of progesterone only pills?

A

inhibition of ovulation. The progestin effect also causes changes in the endometrium and cervical mucous → decreased sperm transport and implantation.

48
Q

What are examples of progesterone only methods?

A

injection
oral (minipill)
IUD
implantable

49
Q

What are indications for the progesterone only pills?

A

Patients who want effective contraception but want or need to avoid estrogen
o Medical contraindications to combo contraception
o Side effects to combo options that prohibit use
o Nursing
Prefer prescribing schedule

50
Q

What issues should be considered w/ progesterone only pills?

A
  • Irregular bleeding (WOMAN WILL NOT HAVE NORMAL PERIODS)
  • Other SE’s from androgenicity
  • Duration of effect and return to fertility
  • Chance of breakthrough ovulation if “pill missed” w/ oral
  • Effects on bone health (Depo)
51
Q

What are the benefits of progesterone only?

A
  • Eventual reduction of menstrual flow
  • NO increased risk of stroke, MI, or thromboembolic event
  • Reduced risk of endometrial cancer or PID (w/ Depo)
52
Q

What instructions do you give a pt on the Minipill?

A
  • First day vs. Sunday vs. immediate
  • Take daily, like combo pill at same time every day
  • No withdrawal bleed week
  • Higher failure rate
  • TIMING CRITICAL (within 3 hours) or backup contraception needed***
53
Q

What is the injectable option of progesterone only?

A

• Medroxyprogesterone acetate (Depo-Provera)

IM every 3 months

54
Q

What are concerns with Depo?

A

bone health (evidence for bone resorption and reduction in bone density → currently recommended for 2 year use!)

*recommend calcium and weight bearing exercise

55
Q

How long does it take women to return to fertility?

A

up to 1 year

56
Q

What are implanon and nexlpanon?

A

Progesterone only

  • Rods implanted subQ under skin – remove once no longer effective
  • Implanon/Nexplanon (etonogestrel) – 1 rod system, effective for 3 years
  • Quick return to fertility
57
Q

How do progesterone only methods affect fertility?

A

quick return to fertility except for depo

58
Q

What is Plan B?

A

Progestin only
OTC for women of all reproductive ages

Less N/V

59
Q

What is the effectiveness of Plan B?

A

95% effective in preventing pregnancy if used w/in 24 hours of unprotected sex

89% effective in preventing pregnancy if used w/in 72 hours of having unprotected sex

60
Q

What is the benefit of Ella?

A

Can be used up to 5 days after unprotected sex

61
Q

What is the mechanism of Ella and related SE?

A
  • Progesterone agonist/antagonist

* SEs: HA, nausea, abd discomfort, dysmenorrhea, fatigue, dizziness

62
Q

How do you dose a combo pill pack (estrogen and progestin) for emergency contraception?

A

Depending on estrogen/progestin dose, take 2 or 4 pills initially within 72 hours of unprotected intercourse and repeating dose in 12 hours

SEs: nausea

63
Q

Can a copper IUD be used for emergency contraception?

A

YES!

64
Q

What must you rule out before inserting an IUD?

A

GC/Chlamydia

65
Q

What is the mechanism of the paragard IUD (copper)?

A

pre-fertilization effect; induces foreign body reaction in endometrium → inflammatory response preventing viable sperm from reaching fallopian tubes

66
Q

How long is the copper IUD effective?

A

10 years

67
Q

Who is a candidate for copper IUD?

A
  • Want more regular periods
  • Want no hormones
  • No h/o dysmenorrhea
  • No h/o menorrhagia
68
Q

What is the mechanism of mirena-levonogestrel?

A

inhibits ovulation; inhibits sperm survival and implantation

69
Q

What are non-contraceptive benefits of mirena?

A

↓ menstrual blood loss and relieves dysmenorrhea

70
Q

How long is mirena affective?

A

5 years

71
Q

Who is an appropriate candidate for mirena?

A
  • OK w/ irregular bleeding and ammenorrhea
  • H/o dysmenorrhea
  • H/o menorrhagia
72
Q

What is skyla?

A

mini version of mirena

effective for3 years

for nulliparous women

73
Q

What is a tubal ligation?

A
  • Laparoscopic procedure
  • Ligation and section removal, clips, rings, coils, plugs, cauterization
  • Can do during Cesarean section or postpartum
  • Main adverse effects are surgery related
  • If pregnancy does occur, higher risk for ectopic
  • Post tubal ligation patients at decreased risk for ovarian cancer
74
Q

What is a non-surgical tubal ligation?

A

• Essure and Adiana - **Less invasive, but 3 months of backup contraception needed **

75
Q

What is a vasectomy?

A

Procedure that results in ligation of the vas deferens

76
Q

How is a vasectomy performed?

A

In physician office under local anesthesia

Safe, effective

77
Q

What are adverse effects of vasectomy?

A

procedural related

78
Q

What post/procedure follow up should occur after a vasectomy?

A

o MUST have semen analysis to assure no motile sperm**
o Approx 20 ejaculations or 3 months following
o Need to use other form of contraception until cleared

Endo/Repro: Week 4 (14 decks)

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